Abstract

INTRODUCTION:

No evaluation of factors associated with remission has been performed in early SpA. The aim of the study was to evaluate percentage of patients in remission using and comparing different definitions of remission, and to evaluate factors associated with remission at inclusion in the prospective DESIR cohort, and after 24 months.

METHODS:

Performance of three definitions (ASAS partial remission [PR], ASDAS-CRP less than 1.3 [ASDAS-R], BASDAI less than 3.6 [BASDAI-R]) were assessed using sensibility, specificity and Youden Index. Data at M0 and M24 were analyzed in uni- and multivariate analysis.

RESULTS:

Seven hundred and six patients were evaluated at M0 and 577 at M24. At M0, percentage of patients in remission was 4% (PR), 8% (ASDAS), 34% (BASDAI), and at M24: 15%, 24% and 54% respectively, in the whole population and similar in Amor, ESSG and ASAS classified patients. BASDAI less than 3.6 had the best sensitivity, and ASDAS-R the best Youden index when using each of the two other definitions of remission as a gold standard. At M24 in multivariate analysis, remission was associated with less smoking, less analgesics, ASAS clinical arm fulfilling, less NSAIDs (ASDAS-R), low CRP (ASDAS-R), low BMI (BASDAI-R). However, over the two years, this study did not allow to demonstrate a relation between remission and structural progression or morbidity.

CONCLUSION:

In this population suggestive of early SpA, smoking and CRP appear as major markers of disease activity in early SpA, and associated with absence of remission.

Un nouvel article scientifique intitulé «Can we use structural lesions seen on MRI of the sacroiliac joints reliably for the classification of patients according to the ASAS axial spondyloarthritis criteria? Data from the DESIR cohort » a été publié dans le journal Ann Rheum Dis.

Abstract

OBJECTIVES:

Investigating the utility of adding structural lesions seen on MRI of the sacroiliac joints to the imaging criterion of the Assessment of SpondyloArthritis (ASAS) axial SpondyloArthritis (axSpA) criteria and the utility of replacement of radiographic sacroiliitis by structural lesions on MRI.

METHODS:

Two well-calibrated readers scored MRI STIR (inflammation, MRI-SI), MRI T1-w images (structural lesions, MRI-SI-s) and radiographs of the sacroiliac joints (X-SI) of patients in the DEvenir des Spondyloarthrites Indifférenciées Récentes cohort (inflammatory back pain: ≥3 months, <3 years, age <50). A third reader adjudicated MRI-SI and X-SI discrepancies. Previously proposed cut-offs for a positive MRI-SI-s were used (based on <5% prevalence among no-SpA patients): erosions (E) ≥3, fatty lesions (FL) ≥3, E/FL ≥5. Patients were classified according to the ASAS axSpA criteria using the various definitions of MRI-SI-s.

RESULTS:

Of the 582 patients included in this analysis, 418 fulfilled the ASAS axSpA criteria, of which 127 patients were modified New York (mNY) positive and 134 and 75 were MRI-SI-s positive (E/FL≥5) for readers 1 and 2, respectively. Agreement between mNY and MRI-SI-s (E/FL≥5) was moderate (reader 1: κ: 0.39; reader 2: κ: 0.44). Using the E/FL≥5 cut-off instead of mNY classification did not change in 478 (82.1%) and 469 (80.6%) patients for readers 1 and 2, respectively. Twelve (reader 1) or ten (reader 2) patients would not be classified as axSpA if only MRI-SI-s was performed (in the scenario of replacement of mNY), while three (reader 1) or six (reader 2) patients would be additionally classified as axSpA in both scenarios (replacement of mNY and addition of MRI-SI-s). Similar results were seen for the other cut-offs (E≥3, FL≥3).

CONCLUSIONS:

Structural lesions on MRI can be used reliably either as an addition to or as a substitute for radiographs in the ASAS axSpA classification of patients in our cohort of patients with short symptom duration.

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to evaluate in radiographic (r) and non-radiographic (nr) axial (ax) spondyloarthritis (SpA) 1) the rate of radiographic sacroiliac joints (SIJ) structural progression 2) to evaluate the predisposing factors of such progression over 2 years.

The main analysis consisted in the evaluation of the switch from nr-to r-axSpA but also other definitions of radiographic progression.

RESULTS:

of the 708 enrolled patients, 449 had baseline and 2-year pelvic radiographs(males: 47%, age: 34±9 years old, B27 positive: 61%, MRI-SIJ positive: 29%) . The % of switch from nr-to-r-axSpA (16/326: 4.9%) and from r-to-nr-axSpA: 7/123 (5.7%) was low. The mean changes in the total SIJ score (o-8) was small 0.1± 0.8 but highly statistically significant (p<0.001). The potential baseline predisposing factors for developing mNY criteria in the multivariate analysis were current smokers, HLAB27 positivity and MRI-SIJ positivity with the following respective odds-ratio: 3.3 [1.0 - 11.5], 12.6 [2.3 - 274] and 498 [9.3 - 904].

CONCLUSION:

Our study suggest that in early SpA: a)The structural progression does exist but is quite small and observed in a small number of patients b) Both environmental (smoking status), genetic (HLAB27 positivity) and inflammatory (MRI-SIJ) markers might be independent predisposing factors of progression. This article is protected by copyright. All rights reserved.

OBJECTIVE:

To examine whether in patients with early inflammatory back pain (IBP) suggestive of spondyloarthritis (SpA), disease manifestations at baseline would combine according to distinguishable ordered phenotypes.

METHODS:

Baseline clinical and demographic characteristics, as well as imaging and biological data of patients included in the French multicenter DESIR cohort were analyzed by multiple correspondence analysis and cluster analysis to identify subgroups of patients, based on shared characteristics.

RESULTS:

Cluster analysis allowed us to classify the 679 patients of the cohort with no missing data into 2 major groups: one with a predominance of isolated axial manifestations and the other with associated peripheral symptoms. The application of the same analysis to selected subsets of the cohort such as HLA-B27 positive and negative patients, and patients fulfilling the Assessment of SpondyloArthritis international Society classification criteria for axial SpA, resulted again in an optimal division of the samples into 2 recurrent clusters of patients, similar to those observed in the whole cohort.

CONCLUSION:

Cluster analysis of SpA manifestations among patients with early IBP highly suggestive of SpA, allowed us to clearly identify at baseline 2 different clinical phenotypes, one with predominant axial, and the other with predominant peripheral manifestations. Ongoing follow up will allow determining whether these clusters may correspond to different severity patterns. This article is protected by copyright. All rights reserved.

Spondyloarthritis (SpA) is a heterogeneous disease with hardly predictable potential courses. We aimed at determining prognostic factors of bad functional outcome at 2 years in patients with early inflammatory back pain (IBP).

METHODS:

Data from patients included in the French multicentre devenir des spondylarthropathies indifférenciées récentes (DESIR) cohort, that is, suffering from IBP starting before 50 years of age and lasting for 3-36 months, were used. A bad functional outcome at 24 months was defined as an increase in bath ankylosing spondylitis functional index (BASFI), or BASFI at 2 years higher than the 75th centile in the cohort. Demographic, clinical, biological and radiological data collected at inclusion were compared in patients with bad functional outcome versus others, by χ(2) test, then by a multivariate logistic regression model with stepwise selection of relevant factors.

We observed, in a large prospective cohort of patients with early IBP, formerly described bad prognostic factors, especially a low educational level, an older age and a high disease activity at onset, and revealed that active smoking status and female sex were also independently associated with a poor outcome. Fulfilment of ASAS criteria, on the other hand, was predictive of a better outcome, most likely due to the more consensual management of a defined disease.

To evaluate the effect of physiotherapy on functional limitation in an observational cohort of early axial spondyloarthritis.

METHODS:

Design: prospective population-based cohort study.

PATIENTS:

708 patients with early axial spondyloarthritis between 2007 and 2010 naive of TNF blockers.

INTERVENTION:

early physiotherapy defined by at least eight supervised sessions of physical therapy during the first six months.

MEASUREMENTS:

the primary outcome was functional improvement defined by a relative improvement of at least 20% in BASFI at six months. Secondary outcomes were improvement in BASFI at one and two years and ASAS20 response criteria at six months.

STATISTICAL ANALYSIS:

a propensity score of having physiotherapy was developed and multivariate analysis using propensity score weighting were used to assess the effect of physiotherapy on outcome.

RESULTS:

Overall, 166 (24%) patients had physiotherapy during the first six months. After using propensity score weighting, there was no functional improvement on the primary outcome in patients treated with early physical therapy (relative risk [IC95%]: 1.15 [0.91-1.45]). No differences were observed on secondary outcomes (relative risk [IC95%]: 0.94 [0.80-1.11]).

CONCLUSIONS:

It seems there is no functional benefit for patients with early spondyloarthritis to be treated early by physiotherapy in daily practice, even though the efficacy of physiotherapy has been shown in several randomized controlled studies.

OBJECTIVE:

To evaluate the effect of tumor necrosis factor (TNF) inhibitors on nonsteroidal antiinflammatory drug (NSAID) intake in a cohort of patients with early axial spondyloarthritis (SpA) over the first 2 years of followup.

METHODS:

The Devenir des Spondylarthropathies Indifférenciées Récentes (DESIR) cohort is a prospective, multicenter, observational study cohortof patients with early inflammatory back pain. The management and treatment of these patients were decided by their treating rheumatologists. Data regarding NSAID intake (yes/no) and the Assessment of SpondyloArthritis international Society NSAID score were collected at each visit over 2 years of followup. Patients receiving a TNF inhibitor were matched with those receiving usual care, based on a propensity score. The NSAID-sparingeffect of TNF inhibitors was estimated by comparing the percentage of patients reaching several end points (e.g., a decrease in the NSAID score to <10 over 2 years) and by modeling NSAID intake using mixed models.

RESULTS:

Among the 627 patients who were followed up, 181 (28.9%) received a TNF inhibitor, and these patients were matched to 181 patients who received usual care. The baseline characteristics of the patients in the 2 groups were comparable (∼40% of the patients were male, and the mean age was 34 years). Initially, 90.2% of patients receiving TNF inhibitors and 90.0% of those receiving usual care had been treated with NSAIDs during the previous 6 months. The number of patients who received an NSAID decreased over time in both groups, but the decrease was greater in the group receiving TNF inhibitors (P = 0.04). The decrease in the median NSAID score was significantly greater in the TNF inhibitor group (54.9 versus 41.9), and the percentage of patients in whom the NSAID score decreased by >50% or to <10 or in whom NSAID treatment was discontinued was greater in the TNF inhibitor group (67.6% versus 46.2%).

CONCLUSION:

Treatment with TNF inhibitors was associated with a decrease in the proportion of patients taking NSAIDs and with a rapid and sustained decrease in NSAID intake. This study is the first to confirm the NSAID-sparing effect of TNF inhibitors in patients with early axial SpA in a real-life clinical setting.